Unexplained infertility (UI), defined as the inability to conceive after 12 months of unprotected intercourse with no diagnosed cause, affects 10% to 30% of infertile couples. An improved understanding of the mechanisms underlying UI could lead to less invasive and less costly treatment strategies. Abnormalities in thyroid function and hyperprolactinemia are well-known causes of infertility, but whether thyrotropin (TSH) and prolactin levels within the normal range are associated with UI is unknown.

Objective

To compare TSH and prolactin levels in women with UI and women with a normal fertility evaluation except for an azoospermic or severely oligospermic male partner.

Design, Setting, and Participants

Cross-sectional study including women evaluated at a large academic health system between 1 January 2000 and 31 December 2012 with normal TSH (levels within the normal range of the assay and ≤5 mIU/L) and normal prolactin levels (≤20 ng/mL) and either UI (n = 187) or no other cause of infertility other than an azoospermic or severely oligospermic partner (n = 52).

Women with UI have higher TSH levels compared with a control population. More studies are necessary to determine whether treatment of high-normal TSH levels decreases time to conception in couples with UI.

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Thank you for sharing this. I wish there was more information about thyroid and male fertility. My husband has newly diagnosed Graves’ disease and we also suffer with IU with s slight male factor. If you have heard of any research on men, I would appreciate if you could share it.

Piecing together the almighty jigsaw that is hypothyroidism has already alerted me to the fact that the cause of my infertility was likely to be undiagnosed hypothyroidism. My TSH was always very "normal" (how I detest that word!) so it was never picked up.

I have tucked away my grief from years of infertility in to a little pocket, where it only tends to affect me if I choose to revisit it. I had one pregnancy, which was an ectopic pregnancy (if there is any research about a link between thyroid and ectopic pregnancy, I would really like to see it).

Another cost to add to my NHS bill that I plan to tot up and go very public with when I've got the energy and brain power!

I’m so sorry to hear of your loss. I totally understand the grief of unexplained infertility. I have also suffered through an ectopic and it’s heartbreaking.

From what I can understand, having a thyroid issue we are more likely to develop endometriosis. This causes build up and scar tissue. When the egg travels down it can sometimes get stuck on the build up/scarring and remain theirs rather than travel to the uterus. I ended up losing my tube, because the tissue from the surgery would have helped create more problems.

Now I’m not saying this is the only explanation and there probably plenty more, but this is what happened to me. Unfortunately the only way to diagnose endometriosis for certain is endoscopic surgery. It may be a route that you may want to try, even if it is just to rule it out. This is information gathered from two gynaecologists and info I’ve found online. It doesn’t help the grief, but it helped me to know the reasoning behind it. I wish you much love for the future with your health. There is light at the end of this dark, long tunnel.... I promise. Feel free to message me if I can help in any other way. xxx

Hi and thank you for your reply. That's interesting re the endometriosis - I'd like to see any info you've got if there are any website links? Not for me, actually, but for a friend.

I'm 50 now and beyond having kids. I was probably about 40 when it stopped becoming so all consuming and devastating. I had every investigation going (apart from adequate thyroid function.... ) in my 30s, including endoscopy, and they couldn't find any reason. My official 'diagnosis' was poorly explained secondary infertility. I remember the desperation of finding the cause. I've not had any endometriosis, but the surgery for my ectopic certainly caused masses of scarring as did my gallbladder removal op.

I'm so sorry you've suffered baby loss yourself through an ectopic. It is devastating. How long ago was it for you? And there is all this support around miscarriage, but not much understanding about ectopics. I gained a lot from using the forums on the Ectopic Pregnancy Trust website, and made some lifelong friends.

Thanks so much for replying, that was so kind! I always find it helpful to talk with people who have been through similar experiences. I'm just dashing out now, but would love to talk more via PM. Take care xx

You’re most welcome. I can’t offer much advice, but we have been round the block a few times with fertility.

We suffered the ectopic in 2014 after coming off birth control. I fell straight away. It was very strange because we had tried for 8 years with our son. Our doctors thought it was a straight forward miscarriage and I was even sent home from the emergency room because no one could offer a scan.

So with our fertility reduced even more because I only had one tube, we thought we were done. Nope, April 2016 our second boy arrived. It was a huge shock to say the least, but I am a firm believer that they will come when they’re ready to.

I don’t have any actual links for you, it was just general browsing one night, but if you google “link between hypothyroidism and endometriosis”, the reading is quite comprehensive. I hope it helps.

Oh you poor thing, gallbladder can be awful, my father in law struggles with it. Hope you feel better now, without it.

I hope everything works out for you and your friend. From my experience, these things seem to be connected, it’s just finding where the link is. Best wishes and best of luck for the future. xxx

Fallopian tubes are clever little things. Before my EP I knew next to nothing about them but I became a bit of an expert afterwards! I'd always thought they were static, like in the text book diagrams, and just stood still waiting for an egg to drop in. But they are active, and move around looking for the egg. They can reach right round to the opposite side to catch an egg that's been released on the other side. So, in itself, losing one tube isn't that big a threat to your fertility.

My GP said I had "typical new mother neurosis" when I told her I was concerned it was an ectopic pregnancy. I could feel it from very early on (about 3 weeks). By the time I got to six weeks, two days, I was on the emergency surgery list, bumping 12 people off the list, and it actually ruptured in surgery.

Good to hear you have two sons

I do feel better for having my gallbladder removed. But I read that it's yet another thing that's related to hypothyroidism. I have cost the NHS an absolute bomb in exchange for them not diagnosing my hypothyroidism...

We have had members who've had miscarriages and I doubt any thought was given to the cause as doctors/endos should be aware but probably don't care how a woman/husband feel when the pregancy doesn't go to full term.

Thank you Yes, I was told "it" was "just a bunch of cells". I think with an ectopic pregnancy they just think you should count yourself lucky you didn't die from it, as it can be fatal if it ruptures. I don't debate that, but it wasn't just a bunch of cells, it was my baby.

The registrar surgeon who performed the op though was absolutely lovely. She actually phoned me up at home to see how I was! The infertility consultant I saw some time afterwards commented that the surgeon had had "her own losses and fertility issues"